Hastings Law Journal


Lars Noah


Disease definitions and clinical judgments routinely affect coverage and reimbursement decisions by health insurers, the licensing determinations of regulatory agencies charged with reviewing new therapeutic technologies, evidentiary and substantive rulings by the judiciary in personal injury lawsuits and criminal trials, eligibility decisions in disability programs, and the resolution of claims before workers' compensation tribunals. This reliance on the definition and identification of disease by the medical profession fails to appreciate the extent to which our conceptions of illness are socially constructed rather than based on value-neutral scientific data and the application of technical expertise.

Just as social forces shape medical practice, legal institutions have influenced nosology and diagnosis, but the nature and consequences of their effects on the definition and identification of disease have gone largely unnoticed. By virtue of their often uncritical reliance on clinical judgments, agencies and courts have, to some extent, distorted and even corrupted medical practice, thereby interfering with the primarily therapeutic purposes underlying diagnostic decision-making by asking physicians, psychiatrists, and clinical researchers to provide answers to difficult legal and political questions. To the extent that medical professionals make diagnostic judgments to serve non-therapeutic purposes, they may work against promoting the best interests of their patients and society.

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